The Effects of Reaming and Intramedullary Nailing on Fracture Healing

Kessler, S; Hallfeldt, Klaus; Perren, S.M.; Schweiberer, L.

doi:10.1097/00003086-198611000-00004

Cited by 145 publications

(68 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…By reaming only until true endosteal "chatter" is encountered, we minimize the possibility of thermal damage. A previous study found that it is the first pass of any reaming that is primarily responsible for the disruption of medullary blood supply [16]. We feel that in the absence of thermal injury (from aggressive reaming), there should be little difference between the passage of an 8 mm reamer versus an 8 mm nail.…”

Section: Discussionmentioning

confidence: 81%

See 1 more Smart Citation

Intramedullary nailing in open tibia fractures: a comparison of two techniques

Ziran

Darowish

Klatt

et al. 2004

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

We analyzed 51 patients with open tibial fractures treated with intramedullary nailing. In 29 patients the nailing was performed without reaming and in 22 after the "reamed-to-fit" technique. There was no statistically significant difference in the rate of union. The nonreamed group required a greater number of secondary procedures to achieve union and had a higher but not statistically significant incidence of infection. Analysis of the operative and anesthesia cost associated with the additional procedures revealed that on average, patients receiving nonreamed nailing incurred a cost of $4,900 more per fracture than patients of the reamed-to-fit technique. The healing rates of open tibia fractures using either minimally reamed or nonreamed techniques of intramedullary nailing are comparable. No increase in the rate of infection with the reamed-to-fit technique was found. A significant increase in the number of secondary procedures required to achieve union was found with the nonreamed nailing technique.Résumé Nous avons analysé 51 malades avec une fracture tibiale ouverte traitée par enclouage centromédul-laire. Pour 29 malades l'enclouage a été exécuté sans alésage et pour 22 avec la technique d'alésage adapté. Il n'y avait aucune différence statistique dans le taux de consolidation. Le groupe sans alésage a exigé un plus grand nombre de gestes secondaires pour obtenir la consolidation et avait un plus grande fréquence d'infection sans que cela soit statistiquement significatif. L'analyse du coût opératoire et de l'anesthésie, associée aux procédures supplémentaires montre qu'en moyenne un malade traité sans alésage a un coût de €4,100 de plus par fracture que le malade avec la technique d'alésage adapté. es taux de consolidation des fractures tibiales ouvertes en utilisant l'enclouage avec alésage adapté ou les techniques sans alésage sont comparables. Aucune augmentation dans le taux d'infection avec la technique d'alésage adapté n'a été trouvée. Une augmentation notable du nombre de procédures secondaires nécessaires pour obtenir la consolidation a été notée avec la technique de l'enclouage sans alésage.

show abstract

Section: Discussionmentioning

confidence: 81%

“…There are many studies that document the severe disruption of endosteal circulation with reaming and subsequent bone necrosis [4,16,19,25]. Klein et al demonstrated a severe vascular insult with aggressive reaming in dog tibiae [17]; Melcher showed an increased rate of infection with reaming in rabbit tibia fractures [20,21].…”

Section: Discussionmentioning

confidence: 99%

Intramedullary nailing in open tibia fractures: a comparison of two techniques

Ziran

Darowish

Klatt

et al. 2004

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…In intact rat hones, total blood flow has reached normal values within I week after intramedullary reaming (Indrekvam et al 1992). On the other hand, fractures are accompanied hy perfusion disturbances of varying degrees, followed by a significant hyperemic response (Kessler et al 1986). Anastomosis between the periosteal and endosteal systems in the cortex have been demonstrated and.…”

Section: Discussionmentioning

confidence: 94%

“…However, aggessive reaming demolishes the endosteal cortex. Apart from the circulatory interruption produced by intramedullary reaming and nailing, the production of a high medullary pressure and occlusion of vessels by fat emboli and dust particles has been reported (Trueta and Cavadias 1955, Danckwardt-Lilliestr0m et al 1970, Kessler et al 1986). In the extensively reamed bones, we used 2.0 mm tightfit nails which may be more effective in blocking the endosteal circulation, thus obstructing efferent flow in a reversed flow pattern.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Restoration of bone flow following fracture and reaming in rat femora

Grundnes

Utvåg

Reikerås

1994

Acta Orthopaedica Scandinavica

View full text Add to dashboard Cite

Intramedullary fixation of distal femoral diaphyseal osteotomies with absorbable self-reinforced poly-L-lactide and metallic intramedullary rods assessed by plain radiographs, quantitative computed tomography, and magnetic resonance imaging: An experimental study in rabbits

Viljanen¹,

Kinnunen²,

Bondestam³

et al. 1998

J. Biomed. Mater. Res.

View full text Add to dashboard Cite

Osteotomies of distal femoral diaphysis were fixed intramedullary with self-reinforced poly-L-lactide acid (SR-PLLA) rods in 19 and with metallic rods in 34 adult rabbits. The follow-up times were 8, 16, 24, and 48 weeks. Plain radiographs, computed tomography (CT), quantitative computed tomography (QCT), and magnetic resonance imaging (MRI) were used to evaluate the bone changes at two different levels of the osteotomy region. There were no significant differences in cortical bone density compared to the intact in the SR-PLLA fixed femurs at the osteotomy site. In the metallic-fixed femurs, the density values were significantly lower as compared to the contralateral femurs. There was a significant reduction of the cortical bone density values in SR-PLLA fixed femurs compared to the intact control side outside the osteotomy area at 8 (p = 0.01), at 16 (p = 0.0001), and at 24 weeks (p = 0.0003). In the metallic-fixed femurs significant reductions at 8 weeks (p = 0.02), at 16 weeks (p = 0.01), at 24 weeks (p = 0.009), and at 48 weeks (p = 0.002) were found compared with the intact control. MRI depicted well the SR-PLLA cases allowing studies without removal of the implant. On the contrary, abundant disturbing metallic artifacts were detected during investigation of the metallic-fixed femurs. In conclusion, our results indicated that CT is useful to evaluate the quality of reduction and internal fixation. Furthermore, the constant presence of internal metallic fixation seems to eventually cause osteoporosis in the cortical region of the femur. However, this stress protection effect of intramedullary fixation on the femoral diaphysis seems to be avoided by using an absorbable SR-PLLA rod, thus resulting in a better quality of bone when the osteotomies are healed.

show abstract

The Effects of Reaming and Intramedullary Nailing on Fracture Healing

Cited by 145 publications

References 0 publications

Intramedullary nailing in open tibia fractures: a comparison of two techniques

Intramedullary nailing in open tibia fractures: a comparison of two techniques

Restoration of bone flow following fracture and reaming in rat femora

Intramedullary fixation of distal femoral diaphyseal osteotomies with absorbable self-reinforced poly-L-lactide and metallic intramedullary rods assessed by plain radiographs, quantitative computed tomography, and magnetic resonance imaging: An experimental study in rabbits

Contact Info

Product

Resources

About